Cardiac uptake of [
            <sup>123</sup>
            I]MIBG separates Parkinson’s disease from multiple system atrophy

Braune, Stefan; Reinhardt, Michaël; Schnitzer, Rita; Riedel, A; Ch, Lücking

doi:10.1212/wnl.53.5.1020

Cited by 311 publications

(217 citation statements)

References 27 publications

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“…The second consisted of parkinsonism (cogwheel rigidity, expressionless face, hypokinesia, stooped posture), without evidence of cerebellar degeneration or dementia, combined with neuroimaging evidence for loss of cardiac sympathetic innervation. [12][13][14][15][16][17][18] was identified by gradually progressive clinical worsening; absent or minimal improvement of movement with levodopa; prominent autonomic abnormalities, such as erectile failure in men, urinary incontinence developing early in the clinical course, and slurred speech; and neuroimaging evidence for intact cardiac sympathetic innervation. Most patients with MSA also had marked OH, but a small subgroup did not.…”

Section: Methodsmentioning

confidence: 99%

Association Between Supine Hypertension and Orthostatic Hypotension in Autonomic Failure

et al. 2003

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Abstract-Supine hypertension occurs commonly in primary chronic autonomic failure. This study explored whether supine hypertension in this setting is associated with orthostatic hypotension (OH), and if so, what mechanisms might underlie this association. Supine and upright blood pressures, hemodynamic responses to the Valsalva maneuver, baroreflex-cardiovagal gain, and plasma norepinephrine (NE) levels were measured in pure autonomic failure (PAF), multiple-system atrophy (MSA) with or without OH, and Parkinson's disease (PD) with or without OH. Controls included age-matched, healthy volunteers and patients with essential hypertension or those referred for dysautonomia. Baroreflex-cardiovagal gain was calculated from the relation between the interbeat interval and systolic pressure during the Valsalva maneuver. PAF, MSA with OH, and PD with OH all featured supine hypertension, which was equivalent in severity to that in essential hypertension, regardless of fludrocortisone treatment. Among patients with PD or MSA, those with OH had higher mean arterial pressure during supine rest (109Ϯ3 mm Hg) than did those lacking OH (96Ϯ3 mm Hg, Pϭ0.002). Baroreflex-cardiovagal gain and orthostatic increments in plasma NE levels were markedly decreased in all 3 groups with OH. Among patients with PD or MSA, those with OH had much lower mean baroreflex-cardiovagal gain (0.74Ϯ0.10 ms/mm Hg) than did those lacking OH (3.13Ϯ0.72 ms/mm Hg, Pϭ0.0002). In PAF, supine hypertension is linked to both OH and low baroreflex-cardiovagal gain. The finding of lower plasma NE levels in patients with than without supine hypertension suggests involvement of pressor mechanisms independent of the sympathetic nervous system. Key Words: hypertension, essential Ⅲ hypotension Ⅲ Parkinson's disease Ⅲ autonomic nervous system Ⅲ sympathetic nervous system Ⅲ norepinephrine P rimary chronic autonomic failure has been classified clinically into 3 forms: pure autonomic failure (PAF), multiple-system atrophy (MSA), and autonomic failure in the setting of Parkinson's disease (PD). 1 All 3 forms typically include orthostatic hypotension (OH), wherein reflexive increases in sympathetic neurocirculatory tone fail to compensate adequately for decreased venous return to the heart.Patients with primary chronic autonomic failure also often have supine hypertension. 2 Because of widespread use of the salt-retaining steroid fludrocortisone to treat OH and literature documenting increases in blood pressure secondary to mineralocorticoid administration, 3,4 supine hypertension in primary chronic autonomic failure might be a side effect of treating the OH and not part of the disease; however, supine hypertension has been reported in a substantial proportion of untreated patients. 5 Analogously, levodopa is a mainstay in the treatment of PD, and based on literature that levodopa produces OH, 6 OH in PD might be a side effect of treating the movement disorder and not part of the disease; however, OH occurs in at least some patients with PD who are off or have never been ...

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Section: Methodsmentioning

confidence: 99%

Association Between Supine Hypertension and Orthostatic Hypotension in Autonomic Failure

et al. 2003

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“…9 On the other hand, MSA patients have intact postganglionic neurons as determined by normal or only slightly decreased plasma norepinephrine, 13 normal or elevated low-frequency variability of blood pressure, 29 and intact cardiac uptake of 6-[18F]flurodopamine 30 or [123I] metaiodobenzylguanide (MIBG) determined by positron emission tomography or single photon emission computed tomography. 31 In contrast, patients with peripheral autonomic failure have very low plasma norepinephrine, 13 greatly decreased low-frequency variability of blood pressure, 29 and absent uptake of 6-[18F]flurodopamine by the heart, 30 as would be expected from a loss of peripheral noradrenergic fibers. These tests have been helpful not only in improving our understanding of the underlying pathophysiology of these disorders, but also in their differential diagnosis.…”

Section: Shibao Et Al Atomoxetine Induces Hypertension 51mentioning

confidence: 99%

Norepinephrine Transporter Blockade With Atomoxetine Induces Hypertension in Patients With Impaired Autonomic Function

et al. 2007

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Abstract-Atomoxetine, a selective norepinephrine transporter blocker, could increase blood pressure by elevating norepinephrine concentration in peripheral sympathetic neurons. This effect may be masked in healthy subjects by central sympatholytic mechanisms. To test this hypothesis we studied the pressor effect of 18 mg of atomoxetine (pediatric dose) in 21 patients with damage of the central (10 subjects) and peripheral (11 subjects) autonomic nervous system. Atomoxetine was administered in a randomized, crossover, placebo-controlled fashion, and blood pressure and heart rate were measured at baseline and for 60 minutes after drug intake. Atomoxetine acutely increased seated and standing systolic blood pressure in patients with central autonomic failure by 54Ϯ26 (meanϮstandard deviation; Pϭ0.004) and 45Ϯ23 mm Hg (Pϭ0.016), respectively, as compared with placebo. At the end of the observation period the mean seated systolic blood pressure in the atomoxetine group was in the hypertensive range (149Ϯ26, range 113 to 209 mm Hg). However, in patients with peripheral autonomic failure, atomoxetine did not elicit a pressor response; seated and standing systolic blood pressure increased by 4Ϯ18 mm Hg (Pϭ0.695) and 0.6Ϯ8 mm Hg (Pϭ0.546) with atomoxetine as compared with placebo. In conclusion, atomoxetine induces a dramatic increase in blood pressure in patients with central autonomic failure even at very low doses. These findings suggest that a functional central sympatholytic pathway is essential to avoid hypertension in patients treated with this drug. Caution should be exercised when this medication is used in patients with milder form of autonomic impairment. Key Words: atomoxetine Ⅲ norepinephrine transporter protein Ⅲ hypertension Ⅲ autonomic nervous system diseases Ⅲ multiple system atrophy

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“…SPECT and raclopride PET; [77][78][79] imaging of cardiac sympathetic denervation; 80,81 as well as various MRI techniques. [82][83][84] Examples of the use of these methods have appeared in the literature of the past decade.…”

Section: I]-(s)-2-hydroxy-3-iodo-6-methoxy-[(1-ethyl-2-pyrrolidinyl)mmentioning

confidence: 99%

“…[77][78][79] Imaging of the cardiac sympathetic system reveals denervation in PD patients, even in early disease stages, and may differentiate between patients with multiple system atrophy (MSA) and PD. 80,81 However, these techniques are not generally able to discriminate between the various atypical parkinsonian syndromes.…”

Section: I]-(s)-2-hydroxy-3-iodo-6-methoxy-[(1-ethyl-2-pyrrolidinyl)mmentioning

confidence: 99%

Neuroimaging and therapeutics in movement disorders

Eckert

Eidelberg

2005

Neurotherapeutics

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Summary:In this review, we discuss the role of neuroimaging in assessing treatment options for movement disorders, particularly Parkinson's disease (PD). Imaging methods to assess dopaminergic function have recently been applied in trials of potential neuroprotective agents. Other imaging methods using regional metabolism and/or cerebral perfusion have been recently introduced to quantify the modulation of network activity as an objective marker of the treatment response. Both imaging strategies have provided novel insights into the mechanisms underlying a variety of pharmacological and stereotaxic surgical treatment strategies for PD and other movement disorders.

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Cardiac uptake of [ ¹²³ I]MIBG separates Parkinson’s disease from multiple system atrophy

Abstract: This population assessment of the heart-mediastinum ratio of [123I]metaiodobenzylguanidine uptake showed a high sensitivity for the detection of autonomic involvement in patients with idiopathic IPD and also a high specificity for the discrimination between idiopathic PD and MSA.

Cited by 311 publications

References 27 publications

Association Between Supine Hypertension and Orthostatic Hypotension in Autonomic Failure

Association Between Supine Hypertension and Orthostatic Hypotension in Autonomic Failure

Norepinephrine Transporter Blockade With Atomoxetine Induces Hypertension in Patients With Impaired Autonomic Function

Neuroimaging and therapeutics in movement disorders

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Cardiac uptake of [ 123 I]MIBG separates Parkinson’s disease from multiple system atrophy

Abstract: This population assessment of the heart-mediastinum ratio of [123I]metaiodobenzylguanidine uptake showed a high sensitivity for the detection of autonomic involvement in patients with idiopathic IPD and also a high specificity for the discrimination between idiopathic PD and MSA.

Cited by 311 publications

References 27 publications

Association Between Supine Hypertension and Orthostatic Hypotension in Autonomic Failure

Association Between Supine Hypertension and Orthostatic Hypotension in Autonomic Failure

Norepinephrine Transporter Blockade With Atomoxetine Induces Hypertension in Patients With Impaired Autonomic Function

Neuroimaging and therapeutics in movement disorders

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Product

Resources

About

Cardiac uptake of [ ¹²³ I]MIBG separates Parkinson’s disease from multiple system atrophy